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USPSTF updates recommendation for breast cancer risk-reducing medications

Women who are at increased risk for breast cancer should engage in “shared, informed decision making” with their physicians when considering use of medications to reduce their cancer risk, according to a US Preventive Services Task Force recommendation.

The recommendation applies to asymptomatic women aged 35 years or older without a prior diagnosis of breast cancer, ductal carcinoma in situ or lobular carcinoma in situ.

Clinicians should offer to prescribe risk-reducing medications — such as the selective estrogen receptor modulators tamoxifen or raloxifene — to women who are at increased risk for breast cancer but are at low risk for adverse effects from the medications, according to the task force.

The recommendation advises against use of tamoxifen, raloxifene or other risk-reducing medications by women who are not at increased risk for breast cancer.

The task force released a draft recommendation in April that coincided with the online publication of a review article in Annals of Internal Medicine.

 

Heidi D. Nelson

In the review, Heidi D. Nelson, MD, MPH, research professor in the departments of medical informatics and clinical epidemiology and medicine at Oregon Health & Science University, and colleagues examined databases and clinical trial registries for data involving the impact of tamoxifen and raloxifene on invasive breast cancer incidence.

Results from seven trials indicated that the drugs yielded a reduction of seven to nine cases per 1,000 women during a 5-year period when compared with placebo.

Findings from the STAR trial demonstrated that tamoxifen reduced breast cancer incidence by an additional five cases per 1,000 compared with raloxifene.

The trials indicated broad benefit; however, subgroup analyses suggested that women at high risk for breast cancer may derive the most benefit with the least harms, Nelson and colleagues wrote.